History: what is the origin of leprosy?
Leprosy holds the title of one of the oldest diseases in the history of mankind, with reports dating back to 1350 BC The official registration took place only in 1873, by the Norwegian physician Gerhard Armauer Hansen, responsible for identifying the bacillus that caused the disease.
In the past, due to lack of specific knowledge, the disease carried a great prejudice, associating the carriers with sin, impurity and dishonor.
Thus, the treatment of patients consisted of excluding them from society, preventing them from visiting social environments, such as churches and schools. In addition, there was a type of marking, in which those who had leprosy were obliged to wear specific clothes and gloves and carry bells that announced their presence.
In Brazil, until 1962, the policy aimed to keep people with the disease away by forcing them to isolate themselves in places called leprosariums and to burn all their belongings.
After compulsory hospitalization ceased to be mandatory, the World Health Organization began to recommend treatment with polychemotherapy, which is the use of
antibiotics offered free of charge to all patients in the world.
The advancement of discoveries and the provision of a cure for leprosy caused 5.4 million registered cases in 1985 to drop to just over 200,000 in 2008.
Currently, the prevalence of the disease is directly linked to poor hygiene conditions, affecting the poorest regions, such as Brazil, India, Madagascar, Mozambique, Myanmar and Nepal.
Brazil is the country with the highest number of leprosy cases in Latin America, with an estimated value of more than 33 thousand patients, and the second in the world, behind India only.
World Leprosy Day
January is marked by the global and national fight against leprosy.
Always celebrated on the last Sunday of January, the World Day Against Leprosy originated through the French journalist Raul Fourreaux, who, in 1954, motivated the United Nations (UN) to remember about the disease until the day when the cure was accessible to everyone.
The date aims to reduce prejudice against people with the disease, who still suffer from judgments based on outdated information. Thus, assistance actions are intensified around the world, with the intention of avoiding contagion and raising awareness about the treatments and cure made available to patients.
In addition, on January 31, it is the National Day for Combating and Preventing Leprosy, a date established by Law No. 12,135 / 2,009.
What are the types of leprosy?
The types of leprosy are classified according to the body’s response to the presence of the bacteria. The disease presents in four clinical forms: indeterminate, tuberculoid or paucibacillary (with few bacilli), borderline or dimorphic and lepromatous or multibacillary (with many bacilli).
Indeterminate leprosy is the initial stage of the disease, which spontaneously evolves to a cure, because the immune system is able to fight the bacteria. In general, there is only a small spot on the skin, hypopigmented or reddish with a disturbance of sensitivity and slightly raised edges. It represents 90% of cases, usually in children.
When leprosy begins at this stage, only 25% of cases progress to other, more severe forms, which can occur in 3 to 5 years.
Tuberculoid or paucibacillary leprosy
Paucibacillary leprosy is the most benign and localized form, which attacks individuals with high resistance to Hansen’s bacillus. The immune system cannot destroy it, but neither does it allow it to spread throughout the body.
This type is characterized by the presence of few bacilli, which may not be detected when samples are taken from the lesions. The disease is not contagious at this stage.
As in the indeterminate form, the lesions that manifest in paucibacillary leprosy are hypopigmented or reddish.
The spots are few, or unique, with well-defined limits, little elevated and numb, which can cause pain and atrophy the nearby muscles, usually in minimal amounts.
Borderline or dimorphic leprosy
Borderline leprosy is considered to be intermediate.
Borderline or dimorphous leprosy is an intermediate form of the disease that results from immunity that is also intermediate. There are more spots on the skin that can reach large areas of the skin, involving parts of healthy skin. It affects the nerves close to the lesions, and acute neuritis of severe prognosis may occur.
Multibacillary, lepromatous or virchowian leprosy
Serious and contagious manifestation of the disease, characterized by the presence of 6 or more skin lesions with many bacilli. Multibacillary leprosy occurs when the patient has an immune system that is unable to control the proliferation of the bacteria, so there are positive samples for Hansen’s bacillus.
Several red, elevated lesions are formed, and in severe cases, nodules appear that can be deforming. Swelling is widespread and there are skin rashes, numbness and muscle weakness.
They usually reach the lobe of the ears and the elbow, but the nose, kidneys and male reproductive organs can also be affected.
What is the most severe type of leprosy?
Virchowian leprosy can be considered the most serious type of the disease, since the immunity of the infected person is null. This causes the bacteria to multiply very quickly. It is common for injuries or more intense wounds to the hands and feet due to the anesthesia that occurs in the limbs.
Why did leprosy change its name?
Since 1976, Brazil has adopted a new terminology for the disease, which until then was called leprosy. The objective, in general, is to end the stigma that the disease carries, making society understand it as something treatable and curable. For this, the Brazilian government invests in campaigns that adopt leprosy and bring clear and objective information.
Causes of leprosy
Leprosy is a disease caused by the bacterium
Mycobacterium leprae, or Hansen’s bacillus, a parasite that especially affects skin cells and nerve cells. The bacterium penetrates the organism through the airways or secretions such as saliva, being transmitted in the same way, until it settles on the peripheral nerves and on the skin.
The incubation time is slow, taking from contamination to the onset of symptoms, on average, from two to five years.
Contamination of the virus can occur from exposure to inadequate hygienic conditions or from intimate contact with the carrier without treatment.
How does leprosy transmission occur?
Among the people who harbor the bacillus, there are situations in which the autoimmune system presents resistance, consisting of cases with a low number of bacteria, unable even to transmit to other people. This form is described as paucibacillary, and can sometimes heal spontaneously.
However, multibacillary cases are potential sources of transmission. A smaller number of individuals have reduced or nonexistent immunity to the bacteria, which multiplies in their body and can infect other people.
Know the ways of transmission:
Direct contact with infected people
The transmission of the disease occurs from contact with the infected patient who is not under treatment. The bacteria are eliminated and transmitted through the respiratory tract amid nasal secretions, saliva droplets,
coughing and sneezing, as in tuberculosis .
However, leprosy is not transmitted as easily as colds, as it depends on intimate and prolonged contact, such as family and friends who share the same house.
It is also believed that there may be transmission through the wounds on the skin. However, it should be remembered that if the leprosy patient is undergoing chemotherapy, there is no risk of transmission.
The manifestation of the disease in the infected person will depend on the individual’s immune system, which may be exposed to the bacillus and be able to decimate it before it causes leprosy. The incubation period is 2 to 5 years.
Contact with animals
Although rare, there are species of animals that carry the bacteria and can transmit them to humans. Research shows that about 60% of armadillos that live in the forests of western Pará may be contaminated with
Mycobacterium leprae. Thus, handling these animals can cause infection.
Other animals that can be vectors are:
What are the risk groups?
affect people of all ages and both sexes, but there is a higher incidence in men than in women. Children are more likely to acquire the disease, however, as it takes longer to manifest, it is common to have more cases reported in adults. Children under fifteen become more ill when leprosy is endemic in their region.
Intimate and prolonged contact with untreated patients is described as the main risk factor, but there are also others, such as:
Hygienic and climatic conditions
The disease is associated with insufficient sanitary conditions, poor hygiene, poor health and poor housing. Dirty, hot and humid environments are ideal for the survival of the bacillus, which is why it is common in countries with temperate, subtropical or tropical climate, such as Brazil.
The people most at risk are those who live in these regions, especially where leprosy is endemic, such as parts of India, China, Japan, Nepal, Egypt, among others. In addition, a large number of people living in the same environment influences the risk of becoming ill.
Contact with animals carrying Mycobacterium leprae
People who deal with certain animals that carry the bacteria on a daily basis are at risk of acquiring it too, especially if they do not wear gloves during contact.
What are the symptoms of leprosy?
Leprosy manifests itself through dermatological and neurological signs and symptoms. Neurological changes, when not properly diagnosed and treated, can cause physical disabilities and deformities.
The disease affects the skin and peripheral nerves, however, it can also affect other regions, such as the eyes (which can cause blindness), eyelashes and eyebrows, the tissues inside the nose, soles and, eventually, some organs .
With the slow incubation period, the individual can become contaminated with the bacteria and only manifest years later.
The disorder is characterized by the appearance of rounded brown, white or reddish spots, sometimes barely visible, which spread throughout the body.
The lesions usually present alterations in the sensitivity, causing the individual to stop feeling differences in temperature, pressure and pain at the wound site. This characteristic that differs leprosy from most skin diseases.
The most common injuries are:
Pigmentary or discromic stains: they result from the alteration – absence, decrease or increase – of melanin or deposit of other pigments and substances on the skin. The spots are white in color.
Plaque: extends over the body for several centimeters, either individually or in a cluster of other lesions.
Infiltration: increased thickness and consistency of the skin, inaccurate limits, sometimes accompanied by redness.
Tuber: little used name, tuber refers to the nodule that evolves leaving a scar.
Nodule: solid lesion, limited, elevated or not, from 1cm to 3cm in size, most of which is more palpable than visible. It can be located in the layers of the epidermis, dermis and / or hypodermis.
The compromised sensitivity of the lesions can occur as follows:
Hypoesthesia: reduced sensitivity.
Anesthesia: absent sensitivity.
Hyperesthesia: increased sensitivity.
In addition to lesions on the skin, leprosy manifests itself through lesions on the peripheral nerves. These injuries are due to an inflammatory process called neuritis, caused both by the action of the bacteria and by the body’s immune reaction to expel the bacillus. In some cases, it can be caused by both.
The lesions are manifested by the following symptoms:
Pain and thickening of the nerves are the first signs of inflammation;
Loss of sensation in the affected innervated limbs, such as eyes, hands and feet;
Impairment of peripheral nerves, characterized by loss of strength in certain innervated muscles, especially in the eyelids and in the upper and lower limbs, such as arms and legs.
Neuritis is an acute process that accompanies severe pain and
edema , swelling caused by fluid retention. The nerve involvement is evidenced when the condition starts to become chronic, causing:
Numbness sensation, caused by inflammation of the nerves;
Changes in the sweat secretion, causing the loss of sweat capacity, consequently, dryness of the skin.
Reduction in muscle strength, characterized by difficulty in holding objects. This causes paralysis in the areas affected by the affected nerves, such as arms or legs;
Untreated neural involvement can cause disabilities and / or deformities due to changes in sensitivity in the affected areas. The change in skeletal muscle occurs mainly in the hands.
The following sensations may also occur:
Impotence and sterility. The infection can reduce the amount of testosterone, as well as the amount of sperm produced by the testicles;
Areas of the skin that have been affected suffer changes in thermal sensitivity and loss of hair;
Lumps or bumps on the coldest parts of the body, such as ears, hands and elbows.
How is leprosy diagnosed?
The dermatologist should be consulted to make an efficient diagnosis based on the observation of spots, analysis of the patient’s symptoms and specific tests. The requested exams can be in the office, to test the sensitivity of the wounds, or laboratorial.
Temperature: the test consists of testing the temperature sensitivity by immersing the affected region in two tubes, one with cold water and the other with hot water.
Pain: to test sensitivity to pain, the tip of a ballpoint pen is pressed on the region affected by the disease.
Touch: it consists of using a thin cotton swab to test the tactile sensitivity.
The dermatologist can order a small scraping of the wounds and send it to laboratories for analysis to confirm the presence of Hansen’s bacillus. The absence of the bacteria discards the multibacillary form, but not the paucibacillary form.
Does leprosy have a cure?
can be cured, but it depends on the patient’s persistence in carrying out the treatment correctly. With medical advances, the disease has a much simpler and more effective treatment. For more than 20 years, the disease has been curable and has high success rates.
What is the treatment of leprosy?
The treatment for leprosy is multidisciplinary, which means encompassing assistance and access to medicines, but also to other specialties that will help prevent complications, as well as help with well-being.
Thus, psychologists, physiotherapists, occupational therapists and general practitioners help in conducting the treatment and its effectiveness.
Leprosy has treatment and cure!
Pharmacological treatment is done through Polychemotherapy (MDT), which involves the use of oral antibiotics that interrupt the evolution of the disease until the complete elimination of the bacteria.
MDT prevents the disabilities and deformities caused by leprosy and breaks the epidemiological chain of the bacillus. Thus, after starting to use the drugs, the disease is no longer transmissible in about 4 days.
Treatment is free , provided by the Unified Health System (SUS), and administered in controlled doses at Basic Health Units, always under the supervision of doctors or nurses. It can last between six months in the paucibacillary form, and one year or more in the multibacillary form.
Certain medications should not be taken by pregnant women. If the patient is pregnant, she must inform the doctor for analysis of alternative methods.
In addition to medication, it is important that there is a whole network of support for the diagnosed person and also for his family.
Psychological monitoring and assessment of other effects of the disease are essential for the improvement to be gradual. It is also important to avoid the risk of abandoning drug treatment.
The treatment of leprosy, carried out using Polychemotherapy (MDT), consists of the associated administration of three antibiotics:
The combination of medications avoids the drug resistance of the bacillus, which is not eliminated with the use of a single medication.
Rifampicin usually eliminates up to 90% of the bacteria, so the need to supplement with Dapsone, which can be used daily at home until the end of treatment. In cases of multibacillary, a daily and a controlled dose of Clofazimine is added.
Information on the classification of the patient is extremely important to select the standard scheme that the drugs will be administered, these varying according to the type of leprosy: Pauci or Multibacillary.
For paucibacillary treatment, a combination of Rifampicin and Dapsone is used, arranged in 6 cards provided to patients. The person must go to a health clinic once a month to receive the monthly dose of Rifampicin and at least one supervised dose of Dapsone.
The discharge criterion consists of 6 supervised monthly doses of rifampicin, for up to 9 months.
The scheme works as follows:
Rifampicin: a supervised monthly dose;
Dapsone: a supervised monthly dose and a self-administered daily dose.
In the multibacillary form, 12 cards are provided to the patient with a combination of Rifampicin, Dapsone and Clofazimine. Once a month, the patient must visit the clinic to receive a supervised dose of each medication. To be discharged, the individual must undergo 12 supervised monthly doses, within 18 months.
The standard scheme for multibacillary occurs as follows:
Rifampicin: a supervised monthly dose;
Clofazimine: a supervised monthly dose and a self-administered daily dose;
Dapsone: a supervised monthly dose and a self-administered daily dose.
Patients who start treatment with numerous lesions may experience slower regression of skin blemishes. Most will continue to improve after 12 months, however, if the individual shows little improvement, 12 additional doses of treatment may be required.
Scheme for children
The dose of the medicines in the standard Pauci and Multibacillary regimen are adjusted with the guidance of a health professional and according to the patient’s age.
For patients who are intolerant to certain drugs in the standard regimen, alternative regimens are indicated, such as ROM, which should be used exclusively to treat paucibacillary patients with a single lesion, without involvement of nerve trunks.
The scheme consists of the following drugs, recommended only for use in referral centers:
Rifampicin: a single supervised dose;
Minocycline: a single supervised dose;
Ofloxacin: a single supervised dose.
Duration of treatment: how long does it take to cure leprosy?
The administration of the supervised dose and
self-medication are essential for the patient to achieve a cure, so the administration schedule should be regulated, preferably every 28 days.
If complications occur during treatment, the patient should be referred to referral centers to receive appropriate guidance. Hospitalization is only indicated in severe cases, such as side effects of medications or the need for surgical corrections for deformities that the disease may have caused. Hospitalization is carried out in general hospitals and soon after discharge, the patient must continue the treatment.
Although he is no longer considered to have leprosy, after the patient has completed the treatment, he should still be under observation by the professionals of the Health Unit to ensure that he will not have post-discharge problems, such as reactions. If they occur, the treatment of polychemotherapy should not be restarted.
The duration of treatment for paucibacillary leprosy is 6 supervised monthly doses of Rifampicin. Regular assistance to the patient is essential to complete the treatment in 6 months, but if the medication is interrupted there is the possibility of being resumed in up to 3 months, with the intention of completing the treatment in up to 9 months.
For multibacillary leprosy, treatment lasts up to 12 supervised monthly doses of Rifampicin. If the treatment is regular, the patient will be able to complete it in up to 12 months. In case of interruption in the medication, the period of up to 6 months is indicated to continue the treatment, so that it can be completed in a maximum of 18 months.
Living with leprosy: tips for taking care of well-being
There is no need to isolate the patient, as the consumption of the first dose of the drug is enough so that the bacteria is not transmitted. However, the individual must continue under treatment to ensure that transmission to relatives and close friends does not occur.
Family members and others close to a leprosy patient should seek a Basic Health Unit to assess the possibilities of also being a carrier.
As Hansen’s bacillus can take time to manifest in the body, the measure is necessary to prevent the transmission of the bacteria from spreading.
If the individual does not show any symptoms, the application of BCG, a vaccine against tuberculosis, may be indicated, since the causative agents of the diseases are similar, so it can assist in prevention.
Complications: what can leprosy cause?
Leprosy does not lead to death, but nerve damage can cause deformities that make it difficult to perform daily activities, such as hand and foot disabilities, paralysis and blindness.
One of the complications caused by the disease is the loss of sensation in the affected limbs, which reduces the individual’s ability to feel pain, the main alert mechanism for aggressions.
In the beginning, numbness is restricted to the injured area, but, by prolonging the period without treating the disease, it also affects and destroys the nerves, causing paralysis in the body and face.
When in this advanced stage of leprosy, the patient is susceptible to not feeling mutilations, burns or traumas in the regions destroyed by the disease.
Without treatment, leprosy can cause permanent damage in several areas of the body, such as:
Blindness or glaucoma ;
Disfigurement of the face (including permanent swelling and nodules);
Erectile dysfunction and infertility in men;
Muscle weakness that leads to conditions such as claw hands or inability to flex the feet;
Damage to the inside of the nose, which can cause hemorrhage and nasal congestion;
Damage to the nerves outside the brain and spinal cord, including the arms, legs and feet.
Treatment of complications
Up to 25% of patients who have undergone leprosy treatment have experienced adverse reactions to medications. To avoid serious complications, it is important for the individual to be under the supervision of a health professional.
How to prevent leprosy?
The best way to prevent the disease is to keep the immune system efficient, so that the body can fight the bacteria in case of contact with it. Therefore, it is recommended that individuals take on new daily habits, with good nutrition, physical activity and good hygiene.
Because of the lack of information, leprosy patients still suffer from prejudice and often end up not seeking the necessary treatment. Share this article to help fight the stigma behind leprosy, which, yes, has a cure!